Data from a European registry of liver failure suggests the incidence of liver disease is increasing with currently about 1 million patients with liver failure in Western Europe, a significant proportion secondary to alcohol. In the majority of patients, liver failure is the result of a precipitating event such as infection or alcoholic hepatitis on the background of established chronic liver disease; an entity that is referred to as “acute-on-chronic liver failure (ACLF)”. Once liver failure is established, specific treatments are limited to organ support and mortality rates approach 50%. In patients with ACLF secondary to severe alcoholic hepatitis (AH), approximately 40% of deaths are thought to result from sepsis.